New Patient Registration Forms

We recognize that your time is valuable. We will make every attempt to see you at your scheduled appointment time. To save time, download our New Patient Registration Form. This may be easily completed using your keyboard and mouse. Print the completed form and fax it to us or bring it with you to your first appointment.

To print our New Patient Registration Form, please click on the link above. You will need Acrobat Reader, which is a free software program available by clicking the Get Adobe Reader button below.

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558 E. Wardlow Road, Long Beach, California 90807 | Phone: 562.427.1221

Dr. Tashiro is a general and cosmetic dentist and he welcomes new patients from all over the Long Beach area including Fountain Valley, Irvine, Los Angeles, and Lakewood. He provides a full range of general and cosmetic dental services for the whole family such as porcelain veneers, Lumineers ®, Invisalign ® clear braces, chair side teeth whitening, cosmetic bonding, porcelain fillings and bridges, porcelain crowns, tooth-colored fillings, digital x-rays, and dental implants, plus teeth cleaning and regular dental check-ups to help find and prevent gum disease and the causes of tooth pain, as well as oral cancer exams.